The Relevance of Biomechanical Analysis in Joint Replacements: A Review

Biomechanical analysis, numerical and experimental, has been extensively used for more than 3 decades to investigate the mechanical behaviour of bone and implant–bone structures in joint replacement. In this review article, a detailed overview of the state-of-the-art techniques used for the development and pre-clinical testing of orthopaedic implants has been presented, with special focus on the hip-joint and hip implants. The efficacies of biomechanical analysis in analysing failure mechanisms in joint replacement, its clinical relevance, challenges and limitations, and future directions have been highlighted. Finite element (FE) modelling and analysis have contributed immensely towards testing of clinical hypotheses and evaluation of implant designs. Over the last few decades, the size and sophistication of the FE models have increased considerably. A critical analysis of the currently available subject-specific FE modelling techniques has been presented including, development of computed tomography-scan-based FE models of bone and implant, assignment of heterogeneous bone material properties, loading and boundary conditions. The relationship between stress–strain analysis and implant failure needs careful interpretation for clinical relevance. Verification and validation of these models are essential for assessing the validity of the predicted results. The salient features of adaptive simulations including bone remodelling and tissue differentiation and its prominence in investigating potential failure mechanisms and implant design evaluations have been discussed. The key considerations for design and development of orthopaedic implants have been suggested. It is envisaged that the FE simulations would be more holistic in nature, incorporating the complexities and variabilities of the clinical problems.